Many people with opioid use disorder (OUD) also have mental illness. Yet, they often do not receive appropriate treatment for either condition.
“These illnesses, especially depression and opioid use disorder—we know how to treat them. The real problem is getting people into treatment and getting them to stay on treatment,” said Katherine Watkins, M.D., M.S.H.S., a psychiatrist and policy researcher at the nonprofit RAND Corporation in Santa Monica, California. “If they stay on treatment, they do better. They don’t die. They don’t have overdoses; they don’t have suicide attempts. They get jobs; they do better.”
Funded through the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, Watkins and Miriam Komaromy, M.D., FACP, an internist and addiction specialist at Boston Medical Center, co-lead a study under the initiative’s program for the development of new strategies to prevent and treat opioid addiction.
“The intersection between mental illness and opioid use disorder is a really important area to address both from a societal standpoint and a scientific standpoint,” said Joshua Gordon, M.D., Ph.D., director of the National Institute of Mental Health (NIMH). Through the NIH HEAL Initiative, NIMH is leading research to study how to treat patients affected by both OUD and mental illness.
In 2015-16, more than two million U.S. adults had an OUD, according to the National Survey on Drug Use and Health, 62% of them had a co-occurring mental illness, and 24% a serious mental illness. However, only 24% and 29.6% of them, respectively, reported receiving treatment for their conditions.
Mental illness, often undiagnosed, increases the risk for OUD and can interfere with a person’s ability to make health care decisions. Patients with a diagnosed mental health condition are more likely to get opioid prescriptions, despite their greater risk of addiction and overdose. Add to the mix other barriers to access proven treatments, such as the stigma that accompanies both conditions, and any patient may face a steep climb to recovery.
One salient barrier to treatment is the scarcity of mental and behavioral health care providers. This is especially true in non-urban areas, many of which are particularly hard-hit by the opioid crisis.
Since primary care providers are more accessible, an important part of the answer could be to treat common mental health and substance use conditions as part of primary care.
This research will explore “how to use a well-known model of combining mental health and physical health care, called Collaborative Care, which has been shown to work for patients with mental illness and other physical conditions, to give better care to those suffering from opioid use disorders and mental illness,” Gordon explained.
Collaborative Care is a specific service delivery model to treat mental and behavioral health conditions in primary care settings, where it adds two key services: care management support for patients receiving behavioral health treatment, and regular consultation with a psychiatric specialist for the primary care team, particularly regarding patients whose conditions are not improving.
Given its proven effectiveness for co-occurring mental and physical health conditions, Watkins and her colleagues want to know if it can do the same for people who have OUD in addition to a mental health condition—specifically, depression or post-traumatic stress disorder.
The team, in collaboration with the University of New Mexico Health Sciences Center, is conducting this research at 11 rural and urban primary care clinics in New Mexico.
The NIH HEAL Initiative supports a wide range of programs to develop new or improved prevention and treatment strategies for opioid addiction, including several to test the effectiveness of Collaborative Care for co-occurring mental health conditions and OUD. These projects include a study at the University of Washington and 24 clinics across the country; a study at the University of Pennsylvania that includes people with anxiety as well as people with depression or PTSD; and a study at the Kaiser Foundation Research Institute in Seattle testing a telephone-based care model.